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Da li je normalno da jako maljava djevojčica od 6 i po godina ima dlake male velusne na naušnicama, na prstima ruku i nogu?

Da, potpuno je normalno da djevojčica od 6 i po godina ima fine velusne dlačice na naušnicama, prstima ruku i nogu, posebno ako je inače maljava.

Razumijevanje normalnog rasta dlaka kod djece

Velusne dlake su fine, meke, nepigmentirane dlačice koje su normalan dio ljudske kože. Prema smjernicama 1, količina, distribucija i napredovanje tjelesnih dlaka kod ljudi ima rasne, porodične, genetske i hormonalne uticaje.

Ključne činjenice o normalnom rastu dlaka:

  • Genetska i etnička varijabilnost: Nordijski i anglosaksonski Evropljani, autohtoni stanovnici Sjeverne i Južne Amerike i Afroamerikanci su generalno manje maljavi od mediteranskih naroda 1
  • Velusne vs. terminalne dlake: Velusne dlake su fine i meke, dok androgeni uzrokuju transformaciju velusnih dlaka u terminalne (deblje, pigmentirane) dlake u androgen-zavisnim područjima 1
  • Prepubertalna hipertrichoza: Hormonalni nivoi su normalni kod prepubertalne jednostavne hipertrichoze 1, što je odgovarajući termin za maljavanje nehorminalnog porijekla

Kada treba biti zabrinut?

Ne treba biti zabrinut u ovom slučaju jer:

  1. Lokacija dlaka: Naušnice, prsti ruku i nogu nisu androgen-zavisna područja
  2. Tip dlaka: Velusne (fine) dlake, ne terminalne (debele, tamne)
  3. Uzrast: 6 i po godina je prepubertalno doba
  4. Porodična sklonost: Dijete je "jako maljavo" što ukazuje na genetsku/porodičnu komponentu

Znakovi upozorenja koji NISU prisutni ovdje:

Prema smjernicama 1, zabrinjavajući znaci hiperandrogenizma kod prepubertalnih djevojčica uključuju:

  • Terminalne dlake (debele, tamne, pigmentirane) na donjim leđima, grudima, stomaku, ramenima, stražnjici i unutrašnjim stranama bedara
  • Rani početak tjelesnog mirisa
  • Aksilarnu ili pubičnu dlaku
  • Ubrzani rast
  • Naprednu koštanu dob
  • Genitalnu maturaciju

Hirzutizam vs. Hipertrichoza

Važno je razlikovati 2:

  • Hirzutizam: Prekomjeran rast dlaka u androgen-zavisnim područjima (gornja usna, brada, grudi, stomak, leđa) - zahtijeva evaluaciju
  • Hipertrichoza: Generalizovano prekomjerno maljavanje u neseksualnom obrascu - obično genetsko/porodično, ne zahtijeva hormonalnu evaluaciju

Ova djevojčica ima hipertrichozu, ne hirzutizam.

Preporuka

Nije potrebna nikakva medicinska evaluacija ili liječenje. Ovo je normalna varijacija rasta dlaka kod prepubertalnog djeteta sa porodičnom sklonošću ka maljanju. Velusne dlake na naušnicama, prstima ruku i nogu su benigna, genetski determinisana karakteristika.

Kada ponovo razmotriti:

Ako se u budućnosti pojave:

  • Brzi razvoj terminalnih dlaka u androgen-zavisnim područjima
  • Menstrualne nepravilnosti nakon puberteta
  • Akne otporne na liječenje sa hirzutizmom
  • Znaci virilizacije (produbljivanje glasa, klitoromegalija)

Tada bi bila indicirana endokrinološka evaluacija 1, 3.

References

1
Guideline

american association of clinical endocrinologists medical guidelines for the clinical practice for the diagnosis and treatment of hyperandrogenic disorders.

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologist, 2001

3
Guideline

guidelines of care for the management of acne vulgaris.

Journal of the American Academy of Dermatology, 2016

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